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INSTRUCTOR: NORAH ALSADHAN, MPH Lecture-2- Key concepts Multiple levels of influence Behavior affect and is affected by multiple determinants at all level of human life Reciprocal causation Individual behavior shapes and is shaped by the social environment. 52-year old women delays getting a mammogram. Possible reason for this occur on all levels of influence. Socioeconomic status: education, income, occupation Skills Culture: norms, values, beliefs Beliefs: one’s own perception of what is true. Not always based on culture. Attitude: a series of beliefs linked together to form patterns of behavior Values: not always valid to assume that health is a strong value for everyone Religion: social behavior, practices, social support Gender: Men eat more fat, less fiber, sleep less, and are more often heavier than women. Knowledge Attitudes Beliefs Personality traits Personal history Psychodynamic theories: Drives and repressed emotion create physical symptom and anxiety Behavioral therapies: Behavior is determined by reinforcement Cognitive theory Behavior is determined by thoughts, feelings, perceptions, goals, and other mental activity Health Belief Model: Perceptions of threat, benefit and barrier to action Transtheoretical Model: Motivation and readiness to change behavior Theory of planned behavior: Attitudes, intentions, beliefs, and control Family, friends, and peers Social identity Social support Social cognitive theory: Triadic influences of self, behavior, and the environment Social influence: Different types of relationships have differing effects on behavior Social support: Support of varying types from other people buffers individuals against the effects of stress. Most theories at these levels are based in Cognitive- behavioral Theory: Behavior is mediated by cognitions Knowledge is necessary but not sufficient to produce most behavior change Perceptions, motivations, skills, and the social environment are key influences on behavior Community Social networks and norms that are informal or formal and serve to guide behavior Community building: uniting people around a common goal using available resources Social networks: the amount of social dyads around each individual Diffusion of innovations: How new ideas, products, and practices spread within a defined population Communication Theory: How different modes of communication influence the behavior of populations and individuals Institutional: Rules, regulations, policies, that constrain or encourage recommended behaviors. Public policy: Multi-level governmental policies and laws that regulate all aspects of health care. No one theory is Adequate Every theory and model has a specific goal What does it try to explain? Is it about how people learn? Is it about how people change? Is it about how people relate to others? Every theory/model is somehow connected to what came before Evolution of understanding Increasing complexity and sophistication Every theory/model has a better/best fit: For particular problems For particular populations For particular interventions Every theory/ model was developed in a cultural and social milieu that may be different from present day People influence the people and situations around them People are influenced by the people and situations around them Example: 56 year-old man with elevated cholesterolworkplace cafeteria provides only fatty-unhealthy food choices. Multiple types of environmental influences affect behavior Natural environment Built environment Multiple-level interventions are usually most effective But most interventions still target the individual Sigmund Freud (1856-1939) Vienna, Austria Studied medicine at university of vienna Specialized in Neurology Unconscious events influence psychic life Unconscious and conscious forces determine: Mental events Experiences Behavior Many physical symptoms are caused by psychological conflicts Id, Ego and Superego Three aspects of most internal (neurotic) conflict This conflict is almost always repressed. True psychic reality Contains instinctual urges Sources of desire for immediate gratification No values, ethics, or logic Obeys the pleasure principle Values and ideals of Society As conveyed by parents Aims for Perfection. The super-ego strives to act in a socially appropriate manner. The super-ego controls our sense of right and wrong and guilt. A type of conscience that punishes misbehavior with feelings of guilt. The executive function Organized and rational Defers gratification Mediates between Id Superego Outer world Obeys the reality principle Id presents ego with an unacceptable wish Ego perceives danger associated with expression of the wish Superego reinforces danger perceptions Defenses are mounted against the wish Balance is struck between wish and defense Sublimation: Manifesting an unacceptable impulse in socially acceptable ways Violence-Surgery Denial: Very commonly used Repression: Involuntary forgetting of a painful feeling or experience Takes many forms: Symptoms Character trait Character style Inhibition Repression remains prominent as an explanation for physical and psychological distress Repression can lead to active suppression of strong emotional expression Changes in immune function Discrepancy between self-reports of distress and physiological state. Type A behavior pattern Risk factor for heart disease Components: Time urgency Orderliness Hostility Irritability with interruptions Hyper alertness Type A behavior pattern Anger and Hostility appear to be most important Predictive relationship between hostility and atrial fibrillation in men (Eaker et al, 2004) Scriptotherapy Pennebaker,1995; Smyth et al.,1999 Disclosure relieves the anxiety and physical stress of repression Interventions using writing about traumatic experiences Immune function and symptoms decreased in Asthma and rheumatoid arthritis.
